Use of biologic mesh for a complicated paracolostomy hernia.
BACKGROUND
Parastomal hernias are among the most frustrating and incapacitating complications of permanent colostomies. Because the traditional surgical options of primary repair with or without ostomy repositioning have led to disappointing results, the use of mesh is indicated, especially in the setting of multiple recurrences.


METHODS
After laparoscopic lyses of adhesions, the colostomy is pushed against the lateral abdominal wall, and a bovine pericardium graft is gently stretched and draped over the colostomy (the Sugarbaker technique). Transfascial sutures and tacks are placed along the perimeter of the mesh and around the colon to prevent small bowel herniation.


RESULTS
The patient developed a small seroma postoperatively, which resolved spontaneously. At his 17-month follow-up, the patient had no evidence of recurrence, he was pain free, and he was satisfied with his cosmetic results.


CONCLUSIONS
Although several studies indicate the feasibility and efficacy of synthetic permanent mesh repair, the concerns of mesh infection, erosion, and ostomy obstruction still persist. The authors suggest parietalizing the bowel and using a biologic mesh.
Lo Menzo
Emanuele
E
Miami VA Healthcare System, University of Miami, Miller School of Medicine, Miami, FL, USA. emanuele.lomenzo@va.gov
Martinez
Jose M
JM
Spector
Seth A
SA
Iglesias
Alberto
A
Degennaro
Vincent
V
Cappellani
Alessandro
A
D000368:Aged; D000818:Animals; D002417:Cattle; D003125:Colostomy / Q000009:adverse effects*; D006555:Hernia, Ventral / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D011138:Polytetrafluoroethylene; D013526:Surgical Mesh; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene